Dr. Matthew Stride spoke on the Total Sport radio program broadcast on BBC Radio Manchester to talk about the incidence of ACL injuries in women’s football.

Dr. Stride, why do you think this seems like a bigger issue with the women’s game rather than the men’s?

MS: This is very topical and there’s no doubt we’re seeing an increase in ACL injuries in women’s football but I think there’s a direct parallel with the increase in intensity and the popularity of women’s football: the number of professional teams has grown considerably; the profile of the WSL; the success of the English national team and a deeper dive on high profile players, unfortunately suffered ACL injuries so it’s certainly very topical at the moment.

From an anatomical perspective, there are associated biomechanical risk factors but I think it’s been said there are some 30+ risk factors for ACL injuries, which are intrinsic and central to the anatomy or to the individual characteristics of the player. Then there are extrinsic factors and one of those is what I was saying related to the training intensity of the women’s game, the professionalism of the game. They’ve gone full time but many of the players haven’t really necessarily progressed through the levels of Academy structure and, as such, the exposure to higher-intensity sports has been relatively later on in their careers.

And if you look at the incidence of injuries, they’re happening a lot more in matches than in training. Training in general can be a little bit more controlled than in matches, where you are challenged by your opposition.

My colleague, Francesco Della Villa, Isokinetic’s Head of the Education and Research Department, is probably one of the most published doctors out there in terms of the ACL injury mechanisms. He has established that there are basically three mechanisms that describe of injury: the jumping mechanism, like a jump and land from a header or a goalkeeper landing; the deceleration movement, which is sort of a classic in football, with sudden cuts and change of direction, or if you’re pressing an opponent, typically for a defensive action; and then also the cutting manoeuvre.

A lot of the research now really shows we have an increase in ACL injuries. We’re looking at specific reasons why. But with that, you know, prevention is always better than cure. You can’t necessarily fully prevent it. You can certainly reduce the risk of injury.

And that’s sort of where a lot of research is heading at the moment.

What can we do to prevent them?

I want to stress the term injury prevention is used, but it is more accurate to talk about injury risk minimisation. I think there always, unfortunately, really are going to be ACL injuries for the foreseeable future, but I think we can certainly do things to reduce the risk. The three injury mechanisms (jumping, deceleration and cutting manoeuvres), these are the classic non-contact mechanisms and at Isokinetic we feel that non-contact ACL injuries is where we can really reduce the risk. That is what we’re working on, what we do, I believe, very well in London.

We have what we call the Green Room, which is essentially like a biomechanical room or lab where we film the movement patterning of individuals, not just professional athletes, etc. Everyday movements of the population that we’ve identified, the high-risk sort of movement patterns, which place that person at a higher risk, and then there is appropriate sort of strengthening and neuromuscular training work you can do to significantly reduce that risk. There’s actually some bit of irony here that the studies that have shown the greatest success of injury prevention or injury risk minimisation programmes have actually largely come from women’s football.

The trouble is that we haven’t necessarily really applied the research well enough, but unfortunately, like, you know, many facets of the women’s game are catching up with the men’s game on that, but the men’s game isn’t perfect either.

Let’s recap the recovery process for this injury, because 10 years ago, it could be totally a career ender, but now it isn’t looking like that.

Yes indeed. Unfortunately, it is still a very significant injury. I think one of the things we have to accept is that there is still a chance players might not get back to the same level of performance as what they had prior to the injury, although every effort is made to ensure that they do so. I always say this is really actually an opportunity for the person or the athlete, it’s almost a cliché, but really try and come back fitter and stronger than they were before they even had the injury in the first place.

I talked about injury prevention, but you’ve got primary prevention, which, frankly, we’re not very good at in general the medical profession, but we need to improve on. This is before an actual injury has happened in the first place. Then secondary prevention is identifying those risk factors, as it were, but also reducing the risk of reinjury. At Isokinetic we’ve got incredible success rates relatively in terms of not only reforming some players getting them back to the high level of performance, but also a very, very low rate of reinjury and I think the key to that is what is called the objective-based criteria. Time in itself did have some relevance, but the general rule is that you have to check other criteria. These are various targets: recovery and muscle strength, recovery of fitness, making sure that movement quality is very good.

In recent years the use GPS data is very useful, and this is where also the women’s game is really quite far behind. We’re catching up with the men’s. Those metrics are running speed, acceleration speed, deceleration speed, you want to make sure that all those targets are met before you’ve got to set the stage for transitioning back into the sport. The first phase (or rehabilitation) is really to try and get pain, swelling and inflammation down, then you want to try and get the range of mobility back within the knee joint. Then the third phase is usually strengthening. The fourth phase is usually more neuromuscular control work. The fifth phase is usually sports-specific – in this case of football-specific – sort of movement patterns.

I think that players are counselled for around about a year, for a 12-month period of time. But it also depends really on other factors, other structures of the knee if they’re also repaired as well, particularly the meniscus.

Some ACL injuries come together with other injuries: ACL injuries plus other collateral ligament injuries plus also the meniscus as well, and that means that needs to be factored into the rehab process and also in terms of the time frame.